Add-on therapy of Levetiracetam (LEV) in difficult-to-treat idiopathic focal epilepsies

Objectives: There are only case reports and a few studies with a small number of patients that report of a good efficacy of LEV in Landau-Kleffner-Syndrom (LKS) and Continous-Spike-Wave-During-Slow-Sleep-Syndrom (CSWS). We report about the add-on therapy of LEV in 21 patients with difficult-to-treat idiopathic focal epilepsy.

Patients and Methods: 21 Patients (14 male; age 5 to 12,8 years, mean age 8,6 years) with rolandic spikes and activation during sleep and pretreatment with valproinacid (VPA) and sulthiame (STM) were given LEV as add-on therapy. Average dose of LEV was 40mg/kg/d (range 15–60mg/kg/d). Epilepsy-Syndroms included Rolandic Epilepsy (RE), LKS; CSWS, atypical benign Partialepilepsy (ABPE) and the combination of symptomatic and idiopathic focal epilepsy.

Responder were defined as a reduction of seizure frequency >50% in comparison to four weeks before starting the therapy with LEV and a lasting effect for at least three month (RS) and/or a notable reduction of paroxysm in the EEG (REEG) and/or a notable improvment in the behaviour/cognition (RBC).

Results: Responder were five of 21 patients (24%). Side-effects (SE) occured in 19% and were mainly sleepiness. Because of side-effects therapy with LEV was stopped in three of twelve patients.

Conclusion: In our patients with difficult-to-treat idiopathic focal epilepsy LEV showed an effect in five patients regarding the reduction of seizure frequency, an improvement of the EEG or the behaviour and cognition. As side-effects occured only in a few patients, therapy with LEV should be considered before starting with steroids.